Over the course of the HIV/AIDS epidemic, women (particularly African-American and Hispanic women) have been increasingly affected. Women now account for 1 in every 3 newly reported cases of HIV infection in the U.S., with two major modes of transmission: heterosexual contact and injection drug use. Research has documented a gender disparity in health care and drug treatment utilization. For example, compared with men, drug-using women receive less medical and psychiatric services, although they have poorer physical and mental health. Drug-using women also have lower retention and treatment completion rates than men in substance abuse treatment. In addition, drug-using women with HIV are less likely than men to receive HIV medication and to adhere to HAART. The factors contributing to these gender differences in minority communities are not fully understood and deserve elucidation through research. The proposed study, using existing dual-site longitudinal data, will examine factors related to gender differences in health care and drug use treatment utilization among Puerto Rican IDUs and crack smokers, a group at high risk for HIV. The two sites studied (New York and Puerto Rico) will provide a comparison of gender disparities in health care, for the same ethnic group in two communities with different resource contexts. The specific aims of the proposed study are: 1) To examine, by gender, factors associated with health care utilization among Puerto Rican drug users in NY and PR; 2) to identify (a) factors mediating the relationship between gender and health care utilization, and (b) interaction effects with gender in the relationships with health care utilization; 3) to examine, by gender, factors associated with drug treatment utilization; 4) to identify (a) factors mediating the relationship between gender and drug treatment utilization, and (b) interaction effects with gender in the relationships with drug treatment utilization; and 5) to assess how the relationships above (#1 - #4) vary between two different health resource environments. In addition, the study will assess whether predictors of HIV medication use differ between women and men over time. The major statistical analyses used will be: multiple logistic regression and hierarchical linear modeling (for longitudinal analysis). Findings will be useful in developing gender-specific interventions to improve health care and drug treatment utilization in women. Gender disparities in health care (including drug treatment) utilization are important public health issues. In particular, among minority drug-using populations, women, as compared to men, receive less medical and psychiatric services, although they experience poorer physical and mental health. However, the factors contributing to these gender differences in minority communities remain under-studied. The proposed study will contribute to an understanding of gender-differentiated healthcare behaviors, and further lead to recommendations to narrow the gender gap. [unreadable] [unreadable] [unreadable] [unreadable]